联合使用胫骨延长柄和金属垫片假体治疗膝关节置换胫骨缺损

Reconstruction of complex proximal tibial defects using the long-stem tibial component combined with metallic wedge

目的 ：探讨联合使用胫骨延长柄和金属垫片假体治疗胫骨缺损在膝关节置换中的应用。方法 ：回顾性分析2011年1月至2013年5月使用胫骨延长柄膝关节假体行人工全膝关节置换的10例（11膝）临床效果。全部为女性,平均年龄67岁（60~77岁）。所有患者行膝关节CT检查,明确其内侧缺损程度,缺损程度均为T2A。均诊断为膝关节骨关节炎。手术前后使用KSS评分进行疗效评价。结果：10例患者平均手术时间100 min,术中使用止血带,术后均不放置引流,不输血。分别从行走能力、上下楼能力、疼痛、稳定性及活动度方面进行评分。与术前相比,术后12个月评分优于术前。未见感染病例。结论：联合使用胫骨延长柄和金属垫片假体作为治疗严重膝关节疾病的方法,术后功能恢复满意,能显著提高胫骨假体的稳定性。

Objective：To investigate results of total knee arthroplasty using the long stem tibial component combined with metallic wedge of knee prosthesis for the treatment of proximal defects. Methods：From January 2011 to May 2013,10 patients（11 knees） were treated with total knee arthroplasties using the long-stem tibial component with metallic tibial wedge of knee prosthesis. All the patients were female and the average age was 67 years old（ranged,60 to 77 years old）. All the patients were osteoarthritis. All the patients were classified as T2 A style. The patients were evaluated according to knee score system（KSS）.Results：All the patients were followed up for 12 months on average（ranged 3 to 29 months）. The clinical outcome was assessed using KSS score,including knee pain score,knee stability score,knee range of motion score and knee walking score,knee stairs score. There were significantly differences at 6 weeks,3 months,6 months and 12 months between pre and postoperative KSS score. Conclusion：The mechanical stability of tibial fixation in primary TKA is significantly increased by using the long stem tibial component with metallic wedge of knee prosthesis,even in the presence of poor proximal bone.